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Value of Aggressive Repeat Hepatectomy for Colorectal Liver Metastases
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J Am Coll Surg
Scientific Forum: 2016 Clinical Congress
inpatient costs aggregated at the hospital level. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. RESULTS: A total of 23,557 patients underwent pancreatic resections at 1,325 hospitals. While the three volume groups had comparable costs, patients who developed a postoperative complication had a higher overall cost (complication vs no complication; median costs $ 38,613 [ IQR $26,067$63,071] vs $ $23,521 [IQR $17,101-$32,217], p<0.001). However, the incidence of postoperative complications (low vs intermediate vs high; 41.43% vs 36.17% vs 32.08%, p<0.001) and subsequent failure-to-rescue (low vs intermediate vs high; 10.75% vs 6.64% vs 5.36%, p<0.001) was lower at high-volume hospitals, correlating with the relatively increased total costs associated with “rescue” at these high-volume hospitals (low vs intermediate vs high; $38,602 vs $38,745 vs $41,746, p<0.001). Table. Study Characteristics by Hospital Volume Tercile Highvolume hospital
Lowvolume hospital
Intermediatevolume hospital
Male, n (%)
3,759 (47.21%)
3,716 (47.84%)
3,748 (48.16)
0.47
CCI 2, n (%)
5,413 (67.88%)
5,221 (67.04%)
5,148 (66.04%)
0.008
Pancreaticoduo-denectomy, n (%)
3,812 (47.81%)
4,517 (58.0%)
4,639 (59.51%)
<0.001
Distal pancreatectomy, n (%)
3,130 (39.25%)
2,301 (29.55%)
2,142 (27.48%)
<0.001
Characteristic
p Value
Teaching hospital, n (%)
4,555 (57.49%)
7,183 (92.67%)
7.703 (98.82%)
<0.001
Urban hospital, n (%)
7,609 (96.04%)
7,493 (96.67%)
7,795 (100%)
<0.001
Postoperative complication, n (%)
3,304 (41.43%)
2,817 (36.17%)
2,501 (32.08%)
<0.001
187 (6.64%)
134 (5.36%)
<0.001
38,745
41,746
<0.001
FTR, n (%) Total Hospital Costs ($)a
355 (10.75%) 38,602
CCI, Charlson Comorbidity Index score; FTR, Failure-to-rescue. a Multivariable hierarchical linear regression analyses adjusting for patient age, gender, CCI, race, insurance status, procedure, postoperative complications, length of stay, hospital teaching status, hospital location, and hospital region.
CONCLUSIONS: High-volume hospitals were associated with higher costs as well as better patient outcomes after pancreatic surgery compared to low-volume hospitals.
Value of Aggressive Repeat Hepatectomy for Colorectal Liver Metastases Yasuyuki Fukami, MD, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama, Shunsuke Onoe Ogaki Municipal Hospital, Gifu, Japan INTRODUCTION: Repeat hepatectomy remains the only curative treatment for recurrent colorectal liver metastases (CLM) after primary hepatectomy. However, the repeat resection rate is still low, and data regarding patient outcome after repeat hepatectomy are deficient. The aim of this study was to investigate the feasibility and prognostic benefit of aggressive repeat hepatectomy for recurrent CLM. METHODS: Data were reviewed from 282 consecutive patients treated by primary curative hepatectomy for CLM between January 1994 and March 2015. Short- and long-term outcomes were analyzed. RESULTS: Of the 282 patients who underwent primary hepatectomy for CLM, 191 patients (68%) developed recurrence, and repeat hepatectomy was conducted in 62 patients. Overall, 62 second, 11 third, 4 fourth, and 1 fifth hepatectomy were performed. The postoperative morbidity and mortality rates in patients who underwent repeat hepatectomy were low (11.5% and 1.3%, respectively). For the recurrence population (n¼191), the overall survival rates at 3 years and 5 years after primary hepatectomy for CLM in the repeat hepatectomy group were 79.1% and 56.2%, respectively, compared to 38.9% and 21.9%, respectively, in the remaining patient cohort who only underwent primary hepatectomy (median survival: 69.9 vs 29.9 months, respectively, p<0.001). Multivariate analysis indicated that R0 resection and postoperative complications were independently associated with overall survival after repeat hepatectomy. CONCLUSIONS: Repeat hepatectomy for CLM is feasible with acceptable perioperative morbidity and mortality and offers longterm survival in selected patients. However, postoperative complication after aggressive repeat hepatectomy for CLM have adverse oncological outcome.
J Am Coll Surg
Scientific Forum: 2016 Clinical Congress
inpatient costs aggregated at the hospital level. Multivariable hierarchical regression analyses were performed to calculate and compare risk-adjusted costs and postoperative outcomes across hospital volume terciles. RESULTS: A total of 23,557 patients underwent pancreatic resections at 1,325 hospitals. While the three volume groups had comparable costs, patients who developed a postoperative complication had a higher overall cost (complication vs no complication; median costs $ 38,613 [ IQR $26,067$63,071] vs $ $23,521 [IQR $17,101-$32,217], p<0.001). However, the incidence of postoperative complications (low vs intermediate vs high; 41.43% vs 36.17% vs 32.08%, p<0.001) and subsequent failure-to-rescue (low vs intermediate vs high; 10.75% vs 6.64% vs 5.36%, p<0.001) was lower at high-volume hospitals, correlating with the relatively increased total costs associated with “rescue” at these high-volume hospitals (low vs intermediate vs high; $38,602 vs $38,745 vs $41,746, p<0.001). Table. Study Characteristics by Hospital Volume Tercile Highvolume hospital
Lowvolume hospital
Intermediatevolume hospital
Male, n (%)
3,759 (47.21%)
3,716 (47.84%)
3,748 (48.16)
0.47
CCI 2, n (%)
5,413 (67.88%)
5,221 (67.04%)
5,148 (66.04%)
0.008
Pancreaticoduo-denectomy, n (%)
3,812 (47.81%)
4,517 (58.0%)
4,639 (59.51%)
<0.001
Distal pancreatectomy, n (%)
3,130 (39.25%)
2,301 (29.55%)
2,142 (27.48%)
<0.001
Characteristic
p Value
Teaching hospital, n (%)
4,555 (57.49%)
7,183 (92.67%)
7.703 (98.82%)
<0.001
Urban hospital, n (%)
7,609 (96.04%)
7,493 (96.67%)
7,795 (100%)
<0.001
Postoperative complication, n (%)
3,304 (41.43%)
2,817 (36.17%)
2,501 (32.08%)
<0.001
187 (6.64%)
134 (5.36%)
<0.001
38,745
41,746
<0.001
FTR, n (%) Total Hospital Costs ($)a
355 (10.75%) 38,602
CCI, Charlson Comorbidity Index score; FTR, Failure-to-rescue. a Multivariable hierarchical linear regression analyses adjusting for patient age, gender, CCI, race, insurance status, procedure, postoperative complications, length of stay, hospital teaching status, hospital location, and hospital region.
CONCLUSIONS: High-volume hospitals were associated with higher costs as well as better patient outcomes after pancreatic surgery compared to low-volume hospitals.
Value of Aggressive Repeat Hepatectomy for Colorectal Liver Metastases Yasuyuki Fukami, MD, Yuji Kaneoka, Atsuyuki Maeda, Yuichi Takayama, Shunsuke Onoe Ogaki Municipal Hospital, Gifu, Japan INTRODUCTION: Repeat hepatectomy remains the only curative treatment for recurrent colorectal liver metastases (CLM) after primary hepatectomy. However, the repeat resection rate is still low, and data regarding patient outcome after repeat hepatectomy are deficient. The aim of this study was to investigate the feasibility and prognostic benefit of aggressive repeat hepatectomy for recurrent CLM. METHODS: Data were reviewed from 282 consecutive patients treated by primary curative hepatectomy for CLM between January 1994 and March 2015. Short- and long-term outcomes were analyzed. RESULTS: Of the 282 patients who underwent primary hepatectomy for CLM, 191 patients (68%) developed recurrence, and repeat hepatectomy was conducted in 62 patients. Overall, 62 second, 11 third, 4 fourth, and 1 fifth hepatectomy were performed. The postoperative morbidity and mortality rates in patients who underwent repeat hepatectomy were low (11.5% and 1.3%, respectively). For the recurrence population (n¼191), the overall survival rates at 3 years and 5 years after primary hepatectomy for CLM in the repeat hepatectomy group were 79.1% and 56.2%, respectively, compared to 38.9% and 21.9%, respectively, in the remaining patient cohort who only underwent primary hepatectomy (median survival: 69.9 vs 29.9 months, respectively, p<0.001). Multivariate analysis indicated that R0 resection and postoperative complications were independently associated with overall survival after repeat hepatectomy. CONCLUSIONS: Repeat hepatectomy for CLM is feasible with acceptable perioperative morbidity and mortality and offers longterm survival in selected patients. However, postoperative complication after aggressive repeat hepatectomy for CLM have adverse oncological outcome.